Diagnostic yield of inpatient video-electroencephalographic monitoring: Experience from a Chinese comprehensive epilepsy center |
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| Institution: | 1. Department of Anesthesiology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510120, PR China;2. Department of Gynecology, The Second People''s Hospital of Shenzhen, Guangdong Province, PR China;3. Department of Anesthesiology and Pain Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China;4. Department of Anesthesiology, The Second People''s Hospital of Shenzhen, Guandong Province, PR China;1. Duke University School of Nursing, United States;2. Division of Endocrinology, Metabolism and Nutrition, Duke University Medical Center, United States;1. Department of Neurology, New York University Langone Medical Center, New York, NY, USA;2. Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA;3. Department of Neurology, Harvard Medical School, Boston, MA, USA;4. Consortia for Improving Medicine Through Innovation and Technology, Boston, MA, USA;5. Department of Neurology, Mayo Clinic Scottsdale, Scottsdale, AZ, USA;6. Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA;7. Department of Pharmacology, USUHS, Bethesda, MD, USA;1. Department of Neurosciences, Medical University of South Carolina, 96 Jonathan Lucas St, MSC 616/CSB 301, Charleston, SC 29425-6160, USA;2. University of Rochester Medicine, Golisano Children''s Hospital, 601 Elmwood Avenue, Box 777R, Rochester, NY 14642, USA;3. Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon St, Suite 303, MSC 835, Charleston, SC 29425-8350, USA;4. Department of Healthcare Leadership and Management, Medical University of South Carolina, 151-B Rutledge Ave, Building B, MSC 962, Charleston, SC 29425-9620, USA;1. Owensboro Medical Health System Neurology, USA;2. Department of Neurology, Vanderbilt University, Nashville, TN, USA;3. Hamad Medical Corporation, Doha, Qatar |
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| Abstract: | Video-electroencephalographic monitoring (VEEG) is useful in the diagnosis of seizure disorders; however, its diagnostic yield in developing countries is not well known. The current study retrospectively reviewed the charts of 484 consecutive patients who were admitted to our center between July 2012 and September 2013. Of these patients, 298 (61.6%) were admitted for diagnostic clarification and underwent VEEG for a mean duration of 1.3 days (range = 1–9 days). The patients were divided into two groups: those whose diagnosis was changed and those whose diagnosis was not changed as a result of VEEG. A patient with a preadmission diagnosis of epilepsy who was discharged with a diagnosis of nonepileptic events (NEEs) or who was further classified as focal/generalized epilepsy on discharge was included in the “change in diagnosis” group. A patient admitted with an uncertain diagnosis and discharged with a diagnosis of NEEs or epilepsy (including focal epilepsy and generalized epilepsy) was also included in the “change in diagnosis” group. Video-electroencephalographic monitoring recorded typical ictal events (epileptic events or nonepileptic events) in 147 (49.3%) of the patients admitted for diagnostic clarification. In total, 181 (60.7%) patients had a change in diagnosis after VEEG. Among them, 103 (56.9%) patients had a preadmission diagnosis of epilepsy, which was further classified as focal epilepsy (88 patients) or generalized epilepsy (15 patients); the diagnosis of NEEs and epilepsy was clarified in 78 (43.1%) patients. The number of patients diagnosed with NEEs increased from 31 (10.4%) on admission to 88 (29.5%) on discharge. Among all the patients admitted for diagnostic clarification, therapeutic plans were changed for 104 (57.5%) patients. In 117 (39.3%) patients with no diagnostic change, VEEG evaluation provided confirmative diagnostic information in 47 (15.8%) patients and no additional diagnostic information in 70 (23.5%) patients. The study indicates that VEEG is useful in terms of clarifying seizure diagnoses and evaluating seizure frequency. In our cohort study, VEEG of a relatively short mean duration produced a comparable diagnostic yield as that reported in other studies. |
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